Outline

Background: TBI is an integral part of several conditioning protocols in stem cell transplan- tion. We report survival and toxicity data of TBI administered in cooperation with Transplant-Center of Deutsche Klinik fÃ¼r Diagnostik (DKD).

Material and Methods: Between 1997 and 2005 280 patients underwent a TBI (40.1% with AML, 19.2% with ALL, 17.4 with CML, 15.6 with NHL and 7.8 with MDS) in 856 fractions. 151 men and 129 women with a mean age of 42 years (16 to 63 years) were treated. The TBI was applied in a sitting position with bilateral open radiation fields using 15-MV-photons of a linear accelerator. Modelling bags (water-sacks) compensate the irregular surface of patient body to homogenize the dose distribution. Anterior-posterior opposed X-ray portals with individual designed lung shields adjust the radiation dose in mediastinum and lateral chestwall. Reduced TBI-dose (<= 8 Gy) was given in 131 patients (46.7%) and myeloablative TBI-dose (> 8 Gy) in 149 patients (53.2 %).

Results: After conditioning with radio- and chemotherapy in 166 cases (59.3%) allogenic unrelated, in 84 cases (30%) allogenic related and in 30 cases (10.7%) autologous stem cell transplantation followed. With a median follow up of 2.1 years 152 patients (54%) are alive, 125 (44%) died. 3 patients are lost of follow up. 134 living patients are in complete remission. CTC grade 3 and 4 toxicity associated with conditioning was found for oral mucosa in up to 90%, for genitourinary tract up to 47%, for gastrointestinal tract in up to 30%, for cutis in up to 24% and for lung up to 8%, mostly occurring combined with the chemotherapy drug VP16. Up to now irradiation induced late effects are rare (cataract in 2 cases).

Conclusion: The “Wiesbaden”-approach is established as a simple, reliable and feasible TBI-method with acceptable toxicity.